Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease

AIM To determine the clinical effectiveness of nutritional counseling on reduction of non-alcoholic fatty liver disease(NAFLD) severity, weight loss, metabolic and anthropometric indexes and liver enzymes.METHODS Forty-six adults with NAFLD received a 6-mo clinical and a dietary intervention(based on Mediterranean diet) carried out respectively by a gastroenterologist and a nutritionist with counseling license. The counseling process consisted of monthly meeting(about 45 min each). The effect of the treatment was evaluated monitoring liver enzymes, metabolic parameters, cardiovascular risk indexes, NAFLD severity [assessed by ultrasound(US)] and related indexes. All parameters were assessed at baseline. Biochemistry was also assessed at mid-and end-interventions and US was repeated at end-intervention.RESULTS The percentage of patients with steatosis grade equal or higher than 2 was reduced from 93% to 48% and steatosis regressed in 9 patients(20%). At the end of the treatment the end-point concerning the weight(i.e., a 7% weight reduction or achievement/maintenance of normal weight) was accomplished by 25 out of 46 patients(i.e., 54.3%). As far as the liver enzymes is concerned, all three liver enzymes significantly decrease during the treatment the normalization was particularly evident for the ALT enzyme(altered values reduced from 67% down to 11%). Several parameters, i.e., BMI, waist circumference, waist-to-hip ratio, AST, ALT, GGT, HDL, serum glucose, Tot-Chol/HDL, LDL/HDL, TG/HDL, AIP, HOMA, FLI, Kotronen index, VAI, NAFLD liver fat score and LAP, showed a significant improvement(P < 0.01) between baseline and end-treatment.CONCLUSION Outcomes of this study further strengthen the hypothesis that Med Diet and more active lifestyle can be considered a safe therapeutic approach for reducing risk and severity of NAFLD and related disease states. The proposed approach may be proposed as a valid and recommended approach for improving the clinical profile of NAFLD patients.

Composition of Trans-anethol and Other Aromatic Volatiles in Anisated Alcoholic Beverages by Head-Space GC-MS Chromatography

Aniseed distillates, like ouzo in Greece, raki in Turkey, pastis in France, and arak in Syria, are very popular in Mediterranean countries. This flavoured alcoholic beverage is produced by extraction and distillation of fermented grape pomaces with herbal seeds from aromatic plants like Pimpinella anisum L., Foeniculum vulgate, Illicium verum and other plants which are also characterized by the presence of congeners which arise during fermentation process. Trans-anethol and its isomer cis-anethol are the main volatiles and are responsible for aroma properties of these traditional aniseed distillates. The aim of this research work was to find the concentration of special aromatic agent, trans-anethol and cis-anethol and also the major aromatic substances which are responsible for the aromatic quality. The majority of their identified components are isolated by extraction and distillation from different commercial brands and homemade samples. The constituents were identified by GC-MS （gas chromatography-mass spectometry） in this traditional spirit. The major constituents in distilled ouzo extract were also trans-anethol.

＂Why Do They Drink？＂ Alcohol Uses and Opinions Towards Alcohol Marketing Communication Messages of Thai Teens

Problem about adolescent drinking has accelerated. Although the alcohol advertisements are restricted by Thai law, nevertheless the alcohol manufactures could still find their way to convey the message about their products to their consumers, including the adolescents in the school system through several marketing communication tactics. To this study, investigated opinion of Thai teens on alcohol use specific to.. （1） types of alcoholic beverages preferred; （2） reason at first alcohol use; （3） future drinking intention; and （4） perceptions toward alcohol marketing communication. The cross-sectional survey was conducted on 5184 students from grades 4th-12th and vocational school in seven regions of Thailand. The data from questionnaires were analyzed using simple descriptive statistic, frequency distribution, and percentages. Those teens reported to start drinking beer because of wanting to experiment with alcohol （41.3%）, to celebrate in special occasion （29.2%）, and due to friends involved （15.7%）. Majority of teens in this study （〉 80%） disagree or strongly disagree with persuasive message of alcohol advertised through several media channels. Most of the samples have good media literacy, know the intention of the marketing communication of the alcohol manufacturers, and could not be persuaded easily. The results required further evaluation for influence of alcohol marketing communication on students＇ alcohol expectancy and alcohol use for proper policy recommendation and management.

Therapeutic strategies for pediatric non-alcoholic fatty liver disease: A challenge for health care providers

Non-alcoholic steato-hepatitis (NASH) is related to insulin resistance and, thus, frequently occurs as part of the metabolic changes that accompany obesity, diabetes and hyperlipidemia. In childhood, the overwhelming boost of obesity and its co-morbidities have lead to the extraordinarily increased prevalence of NASH. Establishing effective therapeutic strategies to treat the disease represents the challenge for hepatologists and gastroenterologists in the next decade. Therapeutic approaches have aimed at treating associated conditions (obesity, insulin resistance, hyperlipemia, etc ) or reducing liver oxidative damage (vitamin E).

Silymarin: An option to treat non-alcoholic fatty liver disease

We have read with a great interest the review published by Singh et al, on the treatment options in alcoholic and non-alcoholic fatty liver disease, including various new targeted therapies that are currently under investigation. Recently, we described the health effects of the Mediterranean diet associated to an antioxidant complex rich in silymarin, to improve in overweight patients anthropometric parameters, glucose and lipid metabolism and intra-hepatic fat accumulation.

Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients.

A substantial proportion of patients with irritable bowel syndrome(IBS) associate their symptoms with the ingestion of specific foods. Therefore, in recent years, scientific research has increasingly focused on the role of diet in IBS and dietary management is now considered an important tool in IBS treatment. This article reviews the main dietary approaches in IBS emphasizing evidence from experimental and observational studies and summarizing the main diet and lifestyle recommendations provided by dietary guidelines and scientific literature. Despite the limited evidence for a beneficial role, general advice on healthy eating and lifestyle is recommended as the first-line approach in the dietary management of IBS. Standard recommendations include adhering to a regular meal pattern, reducing intake of insoluble fibers, alcohol, caffeine, spicy foods, and fat, as well as performing regular physical activity and ensuring a good hydration. Second-line dietary approach should be considered where IBS symptoms persist and recommendations include following a low FODMAP diet, to be delivered only by a healthcare professional with expertise in dietary management. The efficacy of this diet is supported by a growing body of evidence. In contrast, the role of lactose or gluten dietary restriction in the treatment of IBS remains subject to ongoing research with a lack of high-quality evidence. Likewise, further clinical trials are needed to conclude the efficacy of probiotics on IBS symptoms.

Alcohol consumption in patients with primary sclerosing cholangitis

AIM:To assess the alcohol drinking patterns in a cohort of primary sclerosing cholangitis(PSC) patients and the possible influence on the development of fibrosis.METHODS:Ninety-six patients with PSC were evaluated with a validated questionnaire about a patient's lifetime drinking habits:the lifetime drinking history(LDH) questionnaire.In addition,clinical status,transient elastography and biochemistry values were analysed and registered.Patients were defined as having either significant or non-significant fibrosis.Significant fibrosis was defined as either an elastography value of ≥ 17.3 kPa or the presence of clinical signs of cirrhosis.Patients were divided into two groups depending on their alcohol consumption patterns;no/low alcohol consumption(one drink or unit/d) and moderate/high alcohol consumption(≥ 1 drink or unit/d).LDH data were calculated to estimate lifetime alcohol intake(LAI),current alcohol intake,drinks per year before and after diagnosis of PSC.We also calculated the number of episodes of binge-drinking(defined as consuming ≥ 5 drinks per occasion) in total,before and after the diagnosis of PSC.RESULTS:The mean LAI was 3882 units of alcohol,giving a mean intake after onset of alcohol consumption of 2.6 units per week.Only 9% of patients consumed alcohol equal to or more than one unit per day.Current alcohol intake in patients with significant fibrosis(n = 26) was less than in patients without significant fibrosis(n = 70),as shown by lower values of phosphatidylethanol(B-PEth)(0.1 mol/L vs 0.33 mol/L,respectively,P = 0.002) and carbohydrate-deficient transferrin(CDT)(0.88% vs 1.06%,respectively,P = 0.02).Self-reported LAI was similar between the two groups.Patients with significant fibrosis reduced their alcohol intake after diagnosis from 103 to 88 units per year whereas patients without fibrosis increased their alcohol intake after PSC diagnosis from 111 to 151 units/year.There were no correlations between elastography values and intake of alcohol(units/year)(r =-0.036).CONCLUSION:PSC patients have low alcohol consumption.The lack of correlation between fibrosis and alcohol intake indicates that a low alcohol intake is safe in these patients.

落基山，自终点开始的旅程

在艾伯塔省的埃德蒙顿出发,从地面自东向西进入加拿大落基山脉(Canadian Rockies),着实是一种奇特的感受。原本浩瀚无边的北美平原的尽头渐渐出现了壮丽的群山,从隐约到分明,割裂天地,闭锁前路。感觉上,这更像是一次旅程的终结,而非开端。但前路所到之处却非荒芜之地。通过贾斯珀国家公园(Jasper National Park)的收费站后,眼前开始出现数之不尽的不知名山峦、河流、湖泊和绵密的针叶林,景象沉默而壮美;还有各种活跃的野生动物。这块土地充满灵性和生机,仿佛得到了造物主极大的偏爱。